Small Adirondack hospital preps for COVID-19 in the rural North Country’s ‘calm before the storm’

By Adam Federman

Adirondack Health’s medical center in Saranac Lake, the largest hospital in the Adirondack Park, is gearing up to handle potential COVID-19 patients.

It offers a wide array of services from vascular surgery to chemotherapy and operates a handful of satellite offices in Keene, Lake Placid, Tupper Lake, and St. Regis Falls.

The hospital has 51 beds, which includes the eight-bed intensive care unit, and is converting some of its regular rooms for a potential influx of patients with the disease caused by coronavirus, the respiratory infection that first emerged in China late last year and has since spread around the world to claim thousands of lives and upend the global economy.

In addition, the hospital has turned the old ambulatory surgery unit that had already been undergoing renovations into a temporary inpatient facility, increasing capacity for coronavirus patients by 50 percent and adding another four ICU beds.

“I will tell you, I think it’s the calm before the storm,” Adirondack Health Center President and CEO Sylvia Getman said in an interview this week. “We’re planned for that. I certainly hope it doesn’t come to be.”

As the number of confirmed cases in New York City skyrockets—Wednesday morning there were more than 17,000 cases—public health experts expect the virus to make inroads into rural parts of the state. On Wednesday there were four confirmed cases in Essex County, which extends from Lake Champlain through Lake Placid and into parts of Saranac Lake, though testing has been very limited and numbers are likely much higher.

Clinton County has had 90 negative tests and nine positive. The county also has 81 residents quarantined with no symptoms and 10 isolated due to symptoms or positive test results.

St. Lawrence and Franklin counties both reported their first confirmed cases Wednesday, and Franklin County warned of “the possibility of a sharp increase in positive tests and quarantines.”  

“There are still a limited number of test kits available so that is impacting who is being tested,” said Karen Derusha, public information officer for the Clinton County Health Department.

Linda Beers, Essex County Public Health director, said in a statement Tuesday that the area is now confronting community spread and that the “potential for exposure is a reality for everyone.” She encouraged everyone to stay at home as much as possible and to minimize interactions with others.  

Though the Adirondacks is sparsely populated it has a large elderly population, which is especially vulnerable to the health impacts associated with coronavirus. This means that if the pandemic spreads across the North Country, hospitals and clinics could see a surge in patients requiring critical care and ventilators.

Beginning in mid- to late-January, when the first cases were reported in the United States, Getman said, the hospital ran a tabletop exercise to plan for an infectious disease outbreak and has since moved to utilizing an incident command structure to coordinate its response. The hospital also has an infectious disease specialist and safety officer who is an expert in infection control.

The hospital has been screening and testing a small number of individuals who are showing signs of having contracted the virus. Getman said they’re currently only testing inpatients or staff members who may have been exposed. Part of the challenge is the backlog of getting specimens analyzed—Adirondack Health sends the samples to a lab in Albany or to LabCorp—and it can take up to seven days to get the results. There’s also a limited supply of test kits.

Getman said demand for testing has been moderate and when they were operating a drive-through COVID clinic in mid-March they saw 15 to 20 people a day. They have plans to resume the drive-through clinic if necessary.

Like most hospitals across the country, Adirondack Health has a limited supply of critical equipment such as N95 face masks, face shields and ventilators that are essential for ensuring the safety of hospital employees and also saving the lives of patients who may need assistance breathing.

“We’re OK at the moment but it’s not a comfortable position for us to be in,” Getman said.

The hospital has only eight ventilators in the ICU. NYC, as the epicenter of the pandemic in the United States, has been pleading for more supplies with Gov. Andrew Cuomo taking to the airwaves to ask for thousands of additional ventilators.

As the park’s largest employer with about 850 employees, the hospital is also an economic anchor. It has implemented a remote working policy and about 50 employees are now working from home. (Disclosure: The author’s sister is an oncology nurse practitioner at the hospital and is currently working from home.)

“I’m trying to reassure them,” Getman said. “I am very committed to ensuring they have stable employment and the materials they need to stay safe.”

Getman said she has also been heartened and overwhelmed by the response from the community and from the hospital staff. Hotels have called to offer assistance should the hospital need it. The town has provided tents in the event that additional outdoor screening and testing is needed. People have also been dropping off food and even masks.

“I think we work together really well in good times and in bad,” Getman said.

Early on Adirondack Health established a coronavirus hotline for residents seeking information about testing and symptoms. The number goes to a desk line but if no one’s there to pick up it transfers to a cell phone.

At the end of the night shift a nurse who had worked a 14-hour day in the emergency room volunteered to take the cell phone home and put it by her bedside so she could continue answering calls.

“It’s the kind of dedication you can’t be compensated for,” said Getman. “They don’t want people worrying either.”